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Columtiia  ^inibersitp 

in  tije  €itv  of  iSetti  gork 
College  of  ^Ijpssicianjf  anb  ^urgeonsJ 


®r.  CbtDin  ?@»  Crasin 

1859-1918 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/manualofchildbedOOjewe 


MANUAL 


—OF — 


CHILDBED  Nursing 


BY 

CHARLES   JEWETT,  A.M.,  M.  D., 

PROFESSOR   OF  OBSTETRICS   AND   DISEASES   OF  CHILDREN 
AT  THE   LONG   ISLAND   COLLEGE   HOSPITAL. 


New   York  : 
BAILEY  &  FAIRCHILD. 

1893. 


Copyright,  1893, 
By  bailey  &  FAIRCHILD. 


Stuyvesant  Press, 

154  &  156  West  27th  Street, 

New  York. 


PREFACE. 


This  Manual  of  Childbed  Nursing  was  origin- 
ally prepared  for  the  use  of  the  Training  School  for 
Nurses  at  the  Long  Island  College  Hospital.  It  has 
since  been  rewritten  and  adapted  to  general  use. 
Its  object  is  not  so  much  to  furnish  a  text-book  on 
the  subject  as  to  aid  the  pupil  in  remembering  the 
more  important  practical  teachings  of  the  lecture 
course  and  the  ward  training;  hence  the  plan  of 
statement  in  condensed  paragraphs.  The  author 
ventures  the  hope  that  the  book  may  be  found  of 
service  to  graduates  as  well  and  to  all  interested 
in  obstetric   nursing. 

jjo  Clinton  Ave,  Brooklyn,  N.   V., 


MANUAL 


-CF- 


CHILDBED    NURSING. 


PREGNANCY. 

.  Medical  Supervision. — The  pregnant  woman 
should  place  herself  under  the  direction  of  her  physi- 
cian from  the  first  months  of  pregnancy;  should  con- 
sult him  frequently  during  the  latter  months. 

Rules  of  Health. — Most  essential  are  : — 

Daily  open-air  exercise  for  one  or  two  hours; 

Avoidance  of  exhaustion  and  violent  muscular 
exertion; 

Regularity  of  meals ; 

Regulation  of  the  kind  and  quantity  of  food,  as 
the  physician  may  direct; 

Proper  action  of  the  bowels,  once  daily; 

Eight  hours  of  sleep  daily; 

Pure  air  at  all  times; 


6  CHILDBED    NURSING. 

A  sponge  bath  twice  weekly  in  winter,  once 
daily  in  the  summer  months;  should  be  taken  in  a 
warm  room,  and  with  plenty  of  friction  to  secure 
complete  reaction; 

Clothing  to  suit  climatic  changes; 

Light  flannel  underwear  at  all  seasons; 

Avoidance  of  tight  clothing,  especially  about  the 
breasts  and  abdomen. 

Care  of  the  Nipples. — During  the  last  month 
the  nipples  should  be  cleansed  daily  with  a  borax 
solution — tablespoonful  to  a  pint  of  water.  They 
may  be  anointed  with  fresh  cocoa  butter  after  cleans- 
ing, and  if  small  or  sunken  should  be  gently  drawn 
with  the  thumb  and  fingers. 

Examination  of  the  Urine. — Once  a  week  dur- 
ing the  last  month  or  two  a  sample  of  the  urine 
should  be  sent  to  the  doctor  for  examination. 


THE    LABOR. 


THE  LABOR. 

To  Predict  the  Date  of  Labor. — Add  seven  days 
to  the  date  when  the  last  menstruation  began  and 
count  forward  nine  months.  Usually  accurate  within 
a  week. 

Preparation  for  Labor. — For  the  lying-in  cham- 
ber, select,  if  possible,  a  large,  well  ventilated  room 
with  a  southern  exposure,  remote  from  the  water- 
closet,  and  having  no  defective  waste-pipes  nor  other 
exposure  to  house  drainage. 

Cleanliness  of  the  room  and  its  contents,  entire 
freedom  from  decomposing  animal  or  vegetable  mat- 
ter and  the  poisons  of  contagious  disease  are  imper- 
ative. 

Especially  dangerous  is  the  contagion  of  child- 
bed fever,  suppurating  wounds,  erysipelas,  diphtheria 
or  scarlet  fever. 

Much  drapery  is  insanitary;  it  catches  dust  and 
disease  germs. 
Have  Ready: — 

A  dozen  clean  sheets; 

A  dozen  towels  recently  laundered; 

A  dozen  pieces  of  fresh-boiled  cheese-cloth,  or 
butter-cloth,  about  i8  inches  square,  for  wash-cloths; 

Two  or  three  pieces  of  straight  unbleached  mus- 
lin for  binders,  a  yard  and  a  quarter  long  by  half  a 
yard  wide; 

Two  surgically  clean  rubber  sheets,  large  enough. 


"8  CHILDBED    NURSING. 

to  reach  across  the  bed;  table  oilcloth  may  be  sub- 
stituted for  rubber  where  economy  requires; 

A  rug,  rubber  sheet  or  oilcloth,  to  protect  the 
carpet  beside  the  bed; 

Scissors; 

Two  dozen  shield-pins  of  medium  size; 

A  Davidson  or  a  fountain  syringe; 

A  clean  vessel  to  receive  the  placenta; 

A  bedpan  of  earthenware,  or  agate  ironware. 

Plenty  of  hot  and  of  cold  water; 

A  half-pint  of  brandy  or  whiskey; 

Two  or  three  clean  hand-basins  of  agate  ironware 
or  earthenware; 

A  slop  jar; 

Two  new  hand-brushes; 

Two  ounces  of  glycerine  as  a  lubricant  for  the 
doctor's  hands.  Add  a  grain  each  of  the  biniodide 
of  mercury  and  the  iodide  of  potassium; 

A  yard  of  strong,  linen  bobbin,  one-sixteenth 
inch  wide,  for  tying  the  navel-cord; 

Vaseline,  or  sweet  oil,  for  anointing  the  child; 

A  woolen  blanket  for  wrapping  the  child; 

A  child's  bath-tub  and  a  bath  thermometer; 

Castile  soap; 

A  package  of  salicylated  cotton; 

The  child's  clothing. 

Preparation  of  the  Bed. — Cover  the  mattress 
with  a  muslin  sheet  and  that  with  a  rubber  sheet. 

Spread  a  clean  muslin  sheet  over  the  rubber  and 
pin  fast  to  the  mattress. 


THE    LABOR.  ^ 

Spread  over  that  a  second  rubber  covered  with  a 
musUn  sheet. 

Place  two  or  three  fresh  laundered  sheets,  twice 
folded,  in  position  to  receive  and  absorb  the  dis- 
charges. 

A  thick  pad  of  prepared  jute,  or  similar  absorb- 
ent material,  covered  with  fresh-boiled  cheese-cloth^ 
may  be  used  instead  of  the  folded  sheets.  It  should 
be  about  three  feet  square. 

A  separate  cot  dressed  as  above  described  may 
be  used  for  the  confinement  instead  of  the  bed, 
the  patient  being  transferred  to  the  bed  after  de- 
livery. • 

Hygiene  of  the  Lying-in  Room. — The  most 
scrupulous  cleanliness  is  imperative. 

Pure  air  is  at  all  times  indispensable. 

Ventilation  to  be  effective  must  be  constant. 

An  open  fire  is  a  good  ventilator. 

Sunlight  is  an  important  sanitary  agent. 

The  temperature  of  the  room  may  be  from  68°  to 
70°  F.,  five  or  six  degrees  lower  at  night. 

Signs  of  Beginning  Labor. — Pains  in  tJie  lozver 
abdomefi  and  back,  recurring  at  regular  intervals,  at 
first  about  once  a  half-hour.  The  uterus  hardens 
during  the  pains.  (As  the  labor  advances  the  pains 
strengthen  and  the  intervals  shorten  to  one  or  two 
minutes  or  even^the  fraction  of  a  minute  toward  the 
close  of  the  labor.) 

The  **  show,''  a  discharge  of  bloody  mucus  frorr^ 
the  vagina. 


lO  CHILDBED    NURSING. 

Evacnatio7is  of  the  bladder  and  bowels  more  fre- 
quently than  usual. 

Stages  of  Labor. — First  Stage  or  Stage  of 
Dilatation. — Ends  with  the  full  dilatation  of  the 
neck  of  the  womb. 

Second  Stage  or  Stage  of  Expulsion. — Ends 
with  the  birth  of  the  child. 

Third  Stage  or  Placental  Stage. — Ends 
with  the  expulsion  of  the  placenta  and  the  persistent 
contraction  of  the  uterus. 

DUTIES  OF  THE  NURSE  DURING  THE  LABOR. 

First  Stage. — Notify  the  doctor  when  the  labor 
begins  or  be  guided  by  instructions  previously  ob- 
tained. 

Messages  to  the  doctor  are  best  put  in  writing 
and  should  give  stage  of  progress  and  full  particulars. 

Give  the  patient  the  liberty  of  the  room. 

Tell  her  not  to  "bear  down"  during  the  pains  of 
this  stage. 

The  bladder  should  be  frequently  evacuated. 

Empty  the  lower  bowel  by  an  enema  of  warm 
water  in  every  case. 

A  hot  rectal  injection  stimulates  the  pains  and 
therefore  may  or  may  not  be  proper  in  a  given  case. 

Moving  about  the  room  or  even  the  bed  has  a 
like  effect. 

Give  such  simple  food  and  drink  as  the  patient 
may  require. 


THE    LABOR.  II 

For  the  Doctor's  Examination. — Have  ready  for 
the  doctor's  use,  soap,  hot  water,  two  agate  iron- 
ware or  earthenware  hand-basins,  two  hand-brushes 
and  one  of  the  mercurial  solutions  (page  22)  for 
sterilizing  the  hands. 

Place  the  patient  on  her  back  in  bed,  at  the  right 
side,  with  the  clothing  adjusted  for  the  abdominal 
and  the  pelvic  examinations. 

Before  the  first  vaginal  examination  prepare  your 
hands  as  directed  on  page  23  and  carefully  cleanse 
the  external  genitals  and  surrounding  surfaces  with 
soap  and  water,  remove  the  soapy  water  and  bathe 
with  the  biniodide  or  bichloride  of  mercury  solution. 

Second  Stage. — The  patient  should  keep  the  bed 
from  the  time  the  labor  approaches  the  second  stage, 
generally  after  the  escape  of  the  vv^aters  or  after  the 
pains  becom.e  severe;  should  not,  as  a  rule,  be  per- 
mitted to  leave  the  bed  during  the  second  stage, 
not  even  for  evacuations  of  the  bladder  or  bov/els. 

She  should  be  dressed  for  the  bed  with  her  cloth- 
ing tucked  under  the  arms  and  pinned  and  with  a 
folded  sheet  fastened  about  the  waist  in  the  manner 
of  a  skirt. 

Firm  pressure  against  the  lower  part  of  the  back 
during  the  pains  usually  gives  relief. 

The  patient  may  be  allowed  to  pull  upon  the  hand 
of  a  bystander  dujing  the  pains,  or  upon  a  sheet  tied  to 
the  foot  of  the  bed.  This,  however,  increases  the  expel- 
ling power  and  should  be  omitted  in  over-rapid  labor. 

Giving  Chloroform. — Have  the  head  low  and 


II  CHILDBED    NURSING. 

clothing  loose.  Remove  false  teeth.  Smear  the  skin 
abou-t  the  mouth  and  nose  with  vaseline  or  glycer- 
ine, to  prevent  ** burning"  by  the  chloroform. 

Spread  a  thin  towel  over  the  patient's  face;  lift  it 
by  the  middle  so  as  to  form  a  large  air  chamber  about 
the  face. 

Sprinkle  the  chloroform  upon  the  upper  surface 
of  the  towel  opposite  the  mouth  and  nose.  Five  to 
ten  drops  are  usually  enough  for  an  ordinary  pain. 

Give  it  only  during  the  pain,  the  inhalation  begin- 
ning promptly  with  the  pain.  It  may  usually  be 
pushed  to  unconsciousness  during  the  passage  of  the 
head  over  the  perineum. 

For  Version  or  Forceps  Operation. — Place 
the  patient  directly  across  the  bed,  upon  her  back, 
with  the  hips  close  to  the  edge  of  the  bed,  and  the 
knees  drawn  far  up  and  well  apart. 

Each  lower  extremity  may  be  covered  with  a 
separate  sheet  or  blanket. 

One  assistant  is  usually  required  at  each  of  the 
knees  to  hold  them  in  the  position  described. 

Third  Stage. — The  nurse  may  be  required  to 
*'hold  the  fundus  "  while  the  doctor  is  otherwise  en- 
gaged. This  consists  in  "watching"  the  uterus  by 
laying  the  hand  lightly  upon  the  abdominal  wall 
over  the  upper  surface  of  the  uterus  to  know  whether 
it  remains  properly  contracted.  Moving  the  abdom- 
inal walls  in  a  circular  direction  over  the  surface  of 
the  uterus  or  even  grasping  the  womb  may  be 
needed  to  promote  contraction. 


THE    LABOR.  I3 

Keep  the  placenta  for  the  doctor's  examination; 
afterward  destroy  by  burning  in  the  range  or  furnace 
fire. 

At  the  close  of  the  third  stage  the  patient's  body 
should  be  cleansed  of  blood  and  discharges  by  bath- 
ing with  an  antiseptic  lotion — one  of  the  mercurial 
solutions  preferred  (page  22).  Sponges  should  never 
be  used  for  bathing  the  genitals,  but  a  fresh-boiled 
cloth  instead,  which  has  lain  for  several  minutes  in 
the  antiseptic  solution  immediately  before  use. 

Always  resterilize  your  hands  before  contact 
with  the  genital  wounds. 

The  upper  rubber  sheet  should  be  removed  and  all 
soiled  beddingandsoiledclothingreplaced  with  clean. 

A  draw-sheet,  consisting  of  a  clean  muslin  sheet, 
twice  folded,  maybe  placed  under  the  patient's  hips. 
It  should  be  changed  as  often  as  it  becomes  in  the 
least  soiled. 

The  remaining  rubber  sheet  is  not  usually  needed- 
after  four  or  five  days. 

Vulvar  Dressing. — Cover  the  external  genf- 
tals,  after  cleansing,  with  a  folded  napkin  (the 
lochial  guard)  which  has  been  previously  wrung 
out  of  one  of  the  mercurial  solutions  and  dried.  Hold 
in  place  with  a  T  bandage. 

A  good  substitute  for  the  napkin  as  a  vulvar 
dressing  may  be-  made  of  jute  or  other  absorbent 
material  enveloped  in  cheese-cloth.  Boil  for  a  half- 
hour,  dip  in  one  of  the  mercurial  solutions  and  dry 
them.     Burn  after  using. 


14  CHILDBED    NURSING. 

The  Binder  should  reach  from  the  breast-bone 
to  a  point  just  below  the  hips. 

Pin  with  shield-pins  and  moderately  tight  for  the 
first  twelve  hours,  thereafter  less  firmly. 


THE  PUERPERAL  PERIOD. 

Points  to  be  Noted  by  the  Nurse  Twice  or  More 
Daily  During  the  First  One  or  Two  Weeks. 

General  Condition  of  the  Patient. — Ap- 
petite. Color  and  expression  of  the  face.  Appear- 
ance of  the  tongue.     Pains.     Chills. 

Pulse. — Normal  pulse-rate  of  the  puerperal  wo- 
man is  lower  than  the  ordinary  pulse. 

Temperature. — Physiological  upper  limit,  first 
four  days  99J^;  thereafter  99^  F. 

Evacuations  of  the  Bladder  and  Bowels. 

Condition  of  the  Breasts,  whether  distend- 
ed, hard,  painful,  nipples  well  formed,  tender,  or 
cracked. 

Condition  of  the  Abdomen,  bloated,  tender 
on  pressure. 

Condition  and  Size  of  Uterus. — The  uterine 
contractions  should  be  firm;  at  first  intermittent,  after 
about  an  hour,  nearly  or  quite  persistent.  Ten- 
derness on  pressure  over  the  uterus  should  diminish 


THE   PUERPERAL   PERIOD.  1 5 

daily  «nd  should  disappear  after  three  or  four  days. 
Fundus  at  the  close  of  labor  nearly  midway  between 
the  navel  and  the  pubes;  a  few  hours  later  at  the 
navel;  tenth  day  at  the  pubes.  (Note  that  the  uterus 
may  be  pushed  up  bodily  by  a  full  bladder  or  rectum.) 

Character  and  Amount  of  Lochia. — The 
normal  flow  is  more  or  less  bloody  for  about  four 
days,  paler  and  thinner  for  three  or  four,  then 
creamy;  gradually  diminishes  in  quantity  from  the 
close  of  labor.  Total  amount  in  the  first  two  weeks 
about  35-  lbs.  Duration  two  to  four  weeks.  Should 
never  have  a  fetid  odor. 

Watch  closely  the  amount  of  flow  during  the  first 
two  or  three  hours  after  labor. 

Nurse's  Record. — For  the  first  week  or  more 
after  labor  keep  a  concise  daily  record  of  the  case, 
according  to  the  form  on  the  following  pages.  Be- 
gin each  day's  report  upon  a  new  page  or  folio.  Keep 
it  filled  out  to  date  in  readiness  for  the  doctor's  use. 


NURSK'S     DA 


Name  of  Patient: 


,  189 


c 

Ol 


3 

o 

X 


3 


a 
S 

V 


V 

Q 


Diet. 


Lochia: 

Amount, 
Color, 
Odor, 
Clots. 


.V    Record. 


Day  Since  Confinement, 


Jreasts 
and 

[IPPLES. 

Child: 

Pulse,  Temp., 

Micturition, 

Defecation, 

Sleep. 

Remarks. 

- 

- 

l8  CHILDBED    NURSING. 


CARE  OF  THE  PATIENT. 

General  Rules. — The  patient  should  lie  on  the 
back  for  the  first  few  hours  after  labor.  Later  the 
posture  should  be  frequently  changed. 

Sleep  relieves  the  exhaustion  following  labor. 

Rest  and  quiet  are  indispensable. 

During  the  first  week  or  more  exclude  visitors. 

The  nurse  should  sleep  on  a  separate  cot  in  the 
same  room  with  the  patient. 

Give  no  medicine  without  instructions. 

Advise  the  doctor  at  once  of  any  important  ab« 
normal  occurrence  in  childbed. 

Cleanliness. — Absolute  cleanliness  of  the  per- 
son, the  clothing,  and  the  bedding  of  the  patient  is 
imperative. 

A  general  bath  may  be  given  once  in  two  or 
three  days  with  a  fresh  wash-cloth  and  warm  water. 

Replace  the  lochial  guard  with  a  fresh  one  every 
three  to  six  hours  the  first  three  days,  and  at  all 
times  often  enough  to  prevent  the  slightest  bad 
odor. 

The  external  genitals  and  immediate  surround- 
ings should  be  thoroughly  cleansed  with  one  of  the 
antiseptic  solutions  when  the  vulvar  dressing  is 
changed.     Permit  no  fetor. 

Allow  nothing  to  touch  the  genitals  that  has  not 
first  been  sterilized  or  made  germ-free  by  one  of  the 
antiseptic  agents  mentioned  below. 


CARE    OF   THE   PATIENT.  I9 

Vaginal  douches  should  not  be  used  unless  or- 
dered. 

Soiled  lochial  guards  and  all  soiled  linen  should 
be  immediately  removed  from  the  room. 

Diet  may  be  liquid  or  light  solid  food  for  the  first 
day,  especially  if  the  patient  is  much  exhausted  or 
has  taken  an  anaesthetic,  e.  g.,  milk,  gruels,  beef  es- 
sence, animal  broths,  dropped  or  soft-boiled  Qggy 
oatmeal  mush  or  wheaten  grits,  dry  toast  and  v/eak 
tea  or  cocoa. 

Thereafter,  in  the  absence  of  exhaustion,  fever, 
bad  digestion,  or  loss  of  appetite,  a  moderately  full 
diet  as  a  rule. 

Care  of  the  Breasts  and  Nipples. — In  simple  en- 
gorgement of  the  breasts  gentle  massage  with  oiled 
hands,  rubbing  from  the  base  toward  the  nipple,  is 
permissible  if  it  relieves  pain. 

An  inflamed  breast  must  not  be  rubbed. 

Support  by  means  of  a  bandage  is  useful  in  case 
of  over-distension. 

The  patient  must  take  fluids  sparingly  while  the 
breasts  are  engorged. 

The  nipples  should  be  cleansed  after  each  nurs- 
ing, best  with  a  weak  antiseptic  solution,  e.  g.,  a 
saturated  solution  of  salicylic  acid  in  water. 

The  Bladder. — The  bladder  should  empty  itself 
within  eight  hours  after  delivery  and  every  eight 
hours  subsequently. 

Note  carefully  the  amount  and  frequency  of 
urination. 


20  CHILDBED    NURSING. 

Retention  of  urine  may  sometimes  be  relieved  by 
suprapubic  pressure,  hot  fomentations  to  the  pubic 
region,  the  sound  of  running  water,  rectal  injections 
of  warm  water,  or,  with  the  doctor's  permission,  by 
allowing  the  patient  to  sit  up  in  bed  for  voiding 
the  urine. 

Do  not  use  the  catheter  without  consent  of  the 
attending  physician. 

The  Bowels. — The  bowels  should  be  opened  on 
the  third  day  and  once  daily  thereafter. 

This  may  usually  be  accomplished  by  a  rectal  in- 
jection of  two  teaspoonfuls  of  clear  glycerine,  pre- 
viously warmed,  or  an  enema  of  a  quart  of  warm 
water,  or  one  or  two  ounces  of  a  saturated  solution 
of  Epsom  salts,  repeated  as  required. 

Duration  of  Lying-in. — The  patient  should  not 
sit  up  in  bed  for  the  first  week,  except  by  order  of 
the  physician. 

Should  as  a  rule  maintain  a  reclining  posture  on 
the  bed  or  lounge  throughout  the  second  week. 

May,  in  normal  cases,  occupy  her  chair  a  portion 
of  the  day  during  the  third  week. 

May  have  the  Hberty  of  her  room  during  the 
fourth. 

May  leave  her  room  at  the  end  of  a  month,  un- 
less otherwise  directed. 

Use  of  the  Catheter. — Instrument,  a  soft  rubber 
velvet-eyed  catheter  in  good  order. 

Always  boil  the  catheter  for  fifteen  minutes  just 
before  using. 


CARE    OF    THE    PATIENT.  21 

Cleanse  the  hands  as  directed  on  page  23  before 
handhng  the  sterilized  catheter. 

The  patient  should  lie  on  the  back  with  the  knees 
drawn  apart. 

Let  the  patient  or  an  assistant  retract  the  labia 
so  as  to  fully  expose  the  orifice  of  the  urethra  and 
hold  them  apart  till  the  catheter  is  passed. 

Cleanse  the  orifice  and  the  surrounding  surfaces 
with  one  of  the  mercurial  solutions. 

Lubricate  the  catheter  with  clean  vaseline. 

Pass  it,  by  the  aid  of  the  eye,  about  one  and  a 
half  inches,  or  until  the  urine  begins  to  flow. 

Collect  the  urine  in  a  cup  or  small  bowl. 

Prevent  entrance  of  urine  into  the  vagina,  and  its 
^ontact  with  genital  wounds. 

Cleanse  the  instrument  carefullv  after  usinsf. 
-  Repeat  the   evacuation   of  the   bladder  once  in 
eight  hours. 


22  CniLrAliKD    NURSING, 

PREVENTION  OF  CHILDBED  FEVER. 

Childbed  fever  is  caused  by  the  invasion  of  the 
genital  wounds  by  living  microorganisms  or  germs. 

The  carriers  of  the  disease  germs  are  in  nearly 
all  cases  the  hands  of  the  doctor  or  nurse,  instru- 
ments, utensils  or  other  appliances  brought  in  con- 
tact with  the  genitals. 

The  disease  germs  are  destructible  by  certain 
antiseptic  agents. 

Childbed  fever  is,  therefore,  a  preventable  disease. 

Prevention  depends  upon  keeping  everything  that 
comes  in  contact  with  the  birth  canal  germ-free  or 
aseptic  by  the  faithful  use  of  antiseptic  agents,  es- 
pecially during  the  labor  and  for  a  week  at  least 
after  delivery. 

The  following  are  the  best  germ  destroying  or 
Antiseptic  Agents  : — 

Boiling  or  Steaming  for  half  an  hour. 

Dry  Heat  at  234^  F.  for  one  or  two  hours  (bak- 
ing in  an  oven). 

Bichloride  of  Mercury  eight  grains,  common 
salt  eight  grains,  water  one  quart  (a  deadly  poison). 

BiNiODiDE  OF  Mercury  eight  grains,  iodide  of  po- 
tassium eight  grains, water  one  quart  (also  poisonous). 

Chlorinated  Soda  (Labarraque's  Solution)  of 
good  quality,  one  ounce  in  ten  ounces  of  water. 

Carbolic  Acid  one  ounce  and  glycerine  one 
ounce  in  eighteen  ounces  of  water  (not  so  good  as 
the  preceding). 


PREVENTION   OF   CHILDBED   FEVER.  23 

For  cloths,  linen,  utensils,  etc.,  any  of  these 
agents  is  suitable,  except  the  chlorinated  soda  which 
is  destructive  of  the  fabrics. 

For  the  hands,  either  the  bichloride  or  the  binio- 
dide  of  mercury  or  the  chlorinated  soda  solution 
should  be  used;  for  metallic  instruments,  boiling  or 
steaming  for  an  hour. 

Nurse's  Clothing. — The  nurse  should  make 
an  entire  change  of  clothing  immediately  before 
taking  charge  of  an  obstetric  case. 

Should  wear  wash-dresses. 

Her  clothing  should,  be  frequently  changed,  and 
at  all  times  absolutely  clean. 

Care  of  the  Hands. — Should  keep  her  hands 
scrupulously  clean  and  the  nails  cut  short. 

Cleanse  the  hands  as  follows  immediately  before 
contact  with  the  genitals  of  the  obstetric  patient. 

1.  Clean  the  nails  dry. 

2.  Scrub  the  hands  and  forearms  for  three  minutes 
with  hot  water,  soap  and  a  hand-brush,  paying 
special  attention  to  the  nails  and  finger  tips. 

3.  Rinse  in  clean  water. 

4.  Scrub  in  like  manner  with  the  biniodide  or  bichlo- 
ride solution  and  another  hand-brush  free  from  soap. 

Hold  the  hands  for  a  moment  again  in  the  anti- 
septic solution  each  time  before  touching  the  genitals. 

After  sterilizing  refrain  from  wiping  the  hands 
and  touch  nothing  that  is  not  aseptic. 

To  keep  the  hands  soft  after  the  use  of  antisep- 
tics, wash  in  plain  hot  water,  rub  well  with  glycer- 
ine and  water  and  wipe  dry. 


24  CHILDBED    NURSING. 


CARE  OF  THE  CHILD. 

On  Birth  cleanse  the  face  and  especially  the 
eyes,  preferably  with  the  biniodide  or  bichloride  of 
mercury  solution,  and  dry  the  eyes  thoroughly. 

Rub  the  skin  with  sweet  oil  or  vaseline  to  facil- 
itate the  subsequent  removal  of  the  cheesy  matter. 

Wrap  the  child  in  flannel  and  keep  warm.  Care- 
fully avoid  chilling. 

Within  a  few  hours  after  birth  inject  a  tablespoon- 
ful  of  warm  water  into  the  rectum  to  provoke  move- 
ment of  the  bowels,  if  necessary  in  order  to  make 
sure  that  the  rectum  is  pervious. 

Bathing. — Feeble  children  should  not  be  bathed 
for  several  hours,  and  in  some  cases  days,  after  birth. 
Rub  daily  with  sweet  oil  instead. 

The  best  time  for  the  bath  is  a  morning  hour 
midway  between  feedings. 

Use  an  infant's  bath-tub.  Place  it  near  the  heat- 
er or  where  the  temperature  is  about  75^  F. 

Temperature  of  the  water,  98*^  F.,  by  the  ther- 
mometer. 

Keep  the  child's  body  immersed  during  the 
bath,  supporting  the  head  above  the  water  with  the 
hand. 

Duration  of  bath  should  not  exceed  five  minutes. 

Use  a  soft  fresh-boiled  wash-rag  instead  of  a 
sponge. 

Use  Castile  soap  and  little  of  that. 


CARE    OF   THE    CHILD.  2$ 

Cleanse  the  scalp  thoroughly. 

Dry  rapidly  by  enveloping  in  the  towel  with  but 
little  friction.  During  the  first  week  or  two  the  skin 
is  irritable  and  easily  injured  by  chafing. 

In  older  infants  moderately  brisk  friction  with 
the  bare  hand  may  be  used,  after  drying  the  skin,  to 
secure  full  reaction. 

Don't  expose  the  new-born  child"  to  the  slight- 
est chilling. 

Infant  powder  is  usually  unncessary. 

In  case  of  irritation  in  the  folds  of  the  skin,  finely 
powdered  talc,  or  oxide  of  zinc  and  lycopodium  in 
equal  parts  may  be  used  as  infant  powder. 

The  temperature  of  the  bath  may  be  gradually 
reduced  to  90^  F.  by  the  age  of  six  months  if  the 
child  is  robust. 

•    Repeat  the  bathing  daily  in  warm  weather,  twice 
weekly  in  cold. 

Cleanse  soiled  portions  of  the  body  as  often  as 
soiled. 

Navel  Dressing. — Wrap  the  stump  ot  the  navel- 
cord  with  dry  salicylated  cotton  and  lay  to  the  left 
side.  Hold  the  dressing  in  place  with  a  loose  belb/- 
binder  of  thin  soft  flannel. 

Dry  and  re-dress  the  cord  in  the  same  manner 
after  each  bath;  or,  after  the  first  bath,  rubbing  the 
child  with  sweet  oil  mav  be  substituted  for  further 
bathing  till  the  cord  falls  off.  This  usually  happens 
about  the  fifth  day. 

If  the  cord  develops  a  fetid  odor  notify  the  doctor. 


26  CHILDBED    NURSING. 

Clothing. — The  following  is  a  simple  and  con- 
venient dress  for  the  first  half-year. 

1.  The  usual  napkin  of  cotton  or  linen  diaper. 

2.  A  flannel  undershirt  of  the  softest  material, 
without  sleeves  and  opening  in  front. 

3.  A  fine  flannel  dress  with  high  neck  and  long 
sleeves,  cut  a  la  princesses  opening  in  front,  and 
about  twenty-five  inches  in  length. 

4.  A  muslin  slip  of  the  same  style  as  the  flannel 
dress. 

5.  Woolen  socks  reaching  to  the  knees. 

All  clothing,  including  the  belly-band,  should  be 
loose  enough  to  easily  admit  two  or  three  fingers 
underneath  it. 

The  belly-band  is  not  needed  after  the  navel  heals. 

In  all  seasons  children  of  whatever  age  should 
wear  woolen  garments  next  the  skin,  and  the  ex- 
tremities should  be  as  warmly  covered  as  other  por- 
tions of  the  body. 

No  garment  should  be  worn  till  properly  laun- 
dered. 

The  Napkin  should  be  removed  immediately 
when  wet  or  soiled  and  replaced  with  a  clean  one 
fresh  laundered.  Bathe  the  soiled  portions  of  the 
body  with  each  change,  using  plain  warm  water 
without  soap. 

Do  not  permit  the  use  of  strong  alkaline  soaps  or 
washing  powders  for  washing  diapers.  Castile  soap 
ox  borax  may  be  used  instead. 

Nursing. — A    teaspoonful   of  warm   water    un- 


CARE    OF   THE   CHILD.  2/ 

sweetened  may  be  given  now  and  then  but  no  ar- 
tificial food  unless  ordered. 

Put  the  child  to  the  breast  after  the  mother  has 
rested. 

Ten  or  fifteen  minutes  is  sufficient  for  each  nursing. 

Let  it  nurse  once  in  four  hours  until  the  milk 
comes,  then  once  in  two  hours.  Double  one  interval 
in  the  night.  Both  breasts  should  be  nursed  at  each 
nursing. 

Gradually  increase  the  intervals  to  about  three 
hours  by  the  age  of  three  months. 

The  harm  done  by  irregular  nursing  is  a  two- 
fold one  : — 

1.  Digestion  is  hindered  by  feeding  one  meal  be- 
fore the  preceding  meal  is  disposed  of 

2.  The  mother's  milk  becomes  too  rich  with  too 
frequent  nursing  and  too  thin  when  the  intervals 
are  too  long. 

The  breast  inilk  alone  rarely  suffices  after  about 
six  months.  Artificial  feeding  may  then  be  added 
to  the  nursing  and  gradually  increased  till  the  child 
is  wholly  weaned. 

The  usual  time  for  weaning  is  when  the  child  has 
eight  teeth,  or  about  the  twelfth  month. 

Sleep. — The  infant  should  sleep  by  itself  in  a  crib 
or  cradle. 

During  the  first  two  or  three  months  of  its  life  the 
child  requires  eighteen  or  twenty  hours',  at  one  year 
of  age  about  fourteen  hours'  sleep  out  of  the  twenty- 
fo'ir. 


28  CHILDBED    NURSING. 

The  Bowels  should  move  twice,  not  more  than 
four  times  daily.  A  small  soap,  cocoa  butter  or 
glycerine  suppository,  or  the  injection  of  a  tea- 
spoonful  of  warm  glycerine  into  the  rectum  may  be 
used,  as  required,  in  case  of  constipation.  Five  to  ten 
grains  of  manna  or  phosphate  of  sodium,  or  both, 
may  be  added  to  each  feeding  or  given  in  water  as  a 
laxative. 

Warmth  to  the  abdomen  and  gentle  massage  are 
harmless  and  useful  remedies  for  colic. 

Useful  Hints. — Premature  and  feeble  children 
require  special  care  to  keep  them  constantly  warm. 

Should  the  child's  breasts  become  swollen  no 
treatment,  as  a  rule,  is  required. 

Notify  the  doctor  of  the  slightest  discharge  from 
the  eyes. 

The  temperature  of  the  child,  taken  in  the  rectum, 
may  afford  important  information. 

The  infant  may  be  taken  out  of  doors  for  a  few 
hours  daily  in  suitable  weather  after  the  first  month. 

The  child's  habits  w411  be  in  great  part  vv^hat  the 
nurse  makes  them. 


CARE    OF   THE   CHILD.  29 

ARTIFICIAL  FEEDING— DIETARY  OF  IN- 
FANCY AND  EARLY  CHILDHOOD. 

First  Six  Months. — 

Milk  Mixture. 

Cow's  milk — mixed  dairy  milk —  10  ounces."^ 

Water,  previously  boiled,  5        '< 

Milk  sugar    (recrystailized  and  per- 
fectly pure),  6|  drachms. 
Common  salt,  8  grains. t 
Lime-water — just  before  feeding — -       i  ounce. 
Mix. 

Meigs'  Mixture.^ 

Cow's  milk — -mixed  dairy  milk —  2  ounces. 
Cream,  containing  20  per  cent,  of  fat,   3       "        § 

Water,  previously  boiled,  10       " 

Milk  sugar,  6|  drachms. 

Lime-water — just  before  feeding —  i  ounce. 
Mix. 

During  the  first  two  or  three  weeks  the  first  mix- 
ture should  usually  be  reduced  by  adding  three  to 
five  ounces  more  water  than  the  formula  prescribes. 

Either  of  these  mixtures  should  be  prepared,  bot- 
tled and  sterilized  soon  after  the  milk  is  delivered,, 
in  quantity  sufficient  for  the  day's  consumption. 

Sterilize  as  Follows: — Fill  ten  clean  bot- 

*  Use  a  measuring-glass  to  be  had  at  the  drug  stores. 

f  Have  powders-,  each  containing  6j^  drachms  of  milk  sugar 
and  eight  grains  of  salt,  prepared  by  your  druggist,  or  use  for  the 
sugar  a  measure  made  to  hold  one  drachm,  and  add  salt  to  taste, 

t  As  modified  by  Rotch.     Closely  resembles  human  milk. 

§  Best,  that  obtained  by  the  centrifugal  machine,  since  it  may 
be  had  fresh. 


30  CHILDBED    NURSING. 

tles"^  to  the  shoulders,  each  holding  enough  for  one 
feeding.  Plug  the  mouths  with  rubber  stoppers. 
Rubber  stoppers  may  be  had,  specially  made  for  the 
purpose,  at  the  druggists'. 

Stand  the  bottles  in  a  kettle  and  cover  to  the 
shoulders  with  cold  water.     Boil  twenty  minutes. 

Or,  better,  steam  the  bottles  for  thirty  minutes, 
in  a  steam  sterilizing  apparatus  to  be  obtained  at  the 
drug  stores. 

Place  the  stoppers  loosely  in  the  necks  of  the 
bottles  for  the  first  ten  minutes  of  the  boiling,  then 
push  them  in  firmly. 

Keep  on  ice  in  hot  weather. 

Cow's  milk,  to  be  had  in  its  best  state,  must  be 
sterilized  at  the  dairy  immediately  after  milking  and 
served  in  the  sterilizing  cans  or  bottles.  When  the 
can  is  first  opened,  transfer  the  contents  to  the 
nursing-bottles  and  resterilize. 

Feeding. — Warm  the  bottle  to  loo^  F.  before 
feeding,  then  remove  the  stopper,  add  half  a  tea- 
spoonful  of  lime-water  for  each  ounce  of  the  pre- 
pared foodf  and  slip  a  clean  rubber  nipple  over 
the  neck  of  the  bottle.  X 

Let  the  child  nurse  directly  from  the  sterilizing 
bottle. 

*  Or  as  many  as  the  number  of  daily  feedings. 

f  The  addition  of  lime-water  (or  of  baking-soda,  half  a  grain 
to  each  ounce  of  prepared  food)  is  essential  since  cow's  milk  is 
acid,  human  milk  alkaline. 

X  See  "  Partial  Peptonizing,"  p.  32. 


CARE    OF   THE    CHILD. 


31 


Cleanse  the  nipple  inside  and  out  after  each  feed- 
ing, and  the  bottle  in  like  manner. 

Boil  the  nipple  for  ten  minutes  before  using  and 
the  bottles  before  refilling. 

AMOUNT  AND   FREQUENCY. — RULES   FOR    GENERAL 

GUIDANCE. 


INTERVALS 

AMOUNT  AT 

NUMBER  OF 

AVERAGE 

AGE. 

OF 

EACH 

DAILY 

DAILY 

FEEDING. '^ 

FEEDING.f 

FEEDINGS. 

AMOUNT. 

First  dav. 

2  hours. 

I  drachm. 

10 

10  drachms. 

Second  day. 

2  hours. 

I  ounce. 

10 

5  ounces. 

Third  day. 

2  hours. 

I  ounce. 

10 

10  ounces. 

Second  week. 

2  hours. 

1 4  ounces. 

10 

125  ounces. 

Six  weeks. 

2h  hours. 

2i  ounces. 

8 

iS  ounces. 

Three  months. 

3  hours. 

4  ounces. 

6 

24  ounces. 

Six  months. 

3  hours. 

6  ounces. 

6 

36  ounces. 

Small  and  feeble  children  require  to  be  fed  more 
frequently  and  in  smaller  quantities,  large  and  robust 
children  less  frequently  and  in  larger  quantities  than 
the  foregoing  table  prescribes.  The  daily  allowance 
required  must  be  determined  for  the  individual  case 
by  trial. 

The  stomach  capacity,  at  birth,  is  approximately 
Y^  the  weight  of  the  child's  body. 

Take  the  child's  weight  once  a  week  as  a  guide 
to  the  feeding.  A  well  nourished  child  gains  about 
five  ounces  weekly  during  the  first  five  months. 

Peptonized  Milk.— May  be  used  as  a  tem- 
porary expedient  in  cases  of  very  feeble  digestion. 

*  Double  one  interval  in  the  night, 
f  By  measuring-glass. 


32  CHILDBED    NURSING. 

Peptonize  the  contents  of  each  bottle  shortly 
before  feeding-,  as  follows:  For  each  ounce  of  the 
sterilized  mixture  add  extract  of  pancreas*  (Fair- 
child's)  one-fifth  grain,  bicarbonate  of  sodium  three- 
fifths  grain, t  and  shake  till  dissolved.  Stand  the  bot- 
tle in  water  at  the  temperature  of  105^  F.  for  fifteen 
minutes.  If  the  milk  becomes  too  bitter  reduce  the 
time  to  ten  or  even  five  minutes. 

Partial  Peptonizing. — Either  of  the  food  mix- 
tures— p.  29 — should  be  partially  peptonized  for  the 
first  two  or  three  months,  except  in  case  of  the  most 
robust  children.  For  this  purpose  add  the  extract  of 
pancreas  and  the  bicarbonate  of  sodium  to  the  "con- 
tents of  the  nursing-bottle  iimncdiately  before  feed- 
ing and  in  the  proportions  above  stated.  A  partial 
digestion  of  the  food  thus  takes  place  in  the  bottle 
while  the  child  is  nursing  it. 

The  peptonizing,  when  no  longer  required, 
should  be  discontinued  gradually,  by  daily  dimin- 
ishing the  quantity  of  the  peptonizing  powder. 

Six  to  Twelve  Months. — Five  or  six  feedings 
daily,  once  in  3  to  3^  hours.  Average  daily  amount, 
thirty-six  to  forty-eight  ounces. 

Some  farinaceous  material  may,  in  most  cases, 
be  added  to  the  food,  as  follows: 

Bread  Jelly. — Soak  four  ounces  of  stale  w^heat 
meal  (Graham)  bread  in  cold  water  for  six  or  eight 

*  To  be  had  of  the  druggists. 

■f-  Omit  the  lime-water  when  bicarbonate  of  sodium  (baking- 
soda)  is  used. 


CARE    OF   THE   CHILD.  33 

hours.  Then  squeeze  the  water  out  of  it.  Boil  the 
pulp  for  one  and  a  half  hours  in  enough  fresh  water 
to  make  a  thick  gruel.  Rub  through  a  fine  sieve  and 
allow  to  stand.  Mix,  while  fresh,  one  part  of  the 
jelly  thus  formed  with  eight  of  either  of  the  above- 
given  mixtures  (page  29)  before  sterilizing. 

Barley  or  Oatmeal  Gruel. — Boil  for  at  least 
half  an  hour  a  tablespoonful  of  barley  or  oatmeal  in 
one  pint  of  water.  Occasionally  add  water  to  main- 
tain the  original  pint.  Strain  and  add  salt  to  taste. 
Make  fresh  daily.  Combine  with  either  of  the  mix- 
tures in  the  proportion  of  one  part  of  the  gruel  to 
four  of  the  mixture  before  sterilizing. 

Barley  gruel  is  better  if  there  be  looseness  of  the 
bowels,  oatmeal  in  case  of  constipation. 

Undiluted  cow's  milk  mixed,  in  the  proportions 
given,  with  any  of  the  above-named  farinaceous  prep- 
arations, and  sterilized,  is  frequently  well  borne  by 
healthy  children  after  nine  or  ten  months. 

Twelve  to  Eighteen  Months.  —  Four  or  five 
feedings  daily. 

Whole  milk,  sterilized,  with  barley  or  oatmeal 
gruel  or  bread  jelly  in  the  proportions  above 
given. 

Two  or  three  ounces  of  raw  beef  juice,  moderately 
seasoned,  may  be  given  daily,  either  mixed  with  the 
milk  or  separately.  It  should  be  prepared  at  least 
twice  a  day. 

The  simpler  kinds  of  food  requiring  mastication 
may  be  added  after  the  child  has  sixteen  teeth,  such 


34  CHILDBED    NURSING. 

as  oatmeal  and  milk,  or  wheaten  grits,  well  cooked, 
or  stale  bread  and  milk. 

Scraped  beef  or  soft-boiled  eggs  may  be  allowed 
two  or  three  times  weekly. 

Eighteen  Months  to  Two  Years. — Four  or  five 
feedings  daily. 

If  the  child  is  hearty  a  little  fine  cut  meat  may 
be  given  with  the  midday  meal,  such  as  tender 
beef,  lamb  or  chicken.  This,  however,  is  not  es- 
sential. 

Milk  should  be  the  basis  of  the  feeding  till  the 
child  has  all  its  teeth  and  may  constitute  a  part  of 
it  for  several  years  longer.  Milk,  beef  juice  and  the 
farinaceous  preparations  above  mentioned  afford  a 
sufficient  dietary  for  the  entire  period  of  infancy. 

Proprietary  foods  for  infants  are  not  to  be  recom- 
mended. 

Two  to  Three  Years. — May  sit  at  the  table.  Add 
to  the  dietary  fine  cut  beefsteak,  roast  beef,  chicken, 
turkey,  fresh  fish,  mashed  potato,  fruits,  bread  and 
butter. 

Three  to  Five  Years.  —  Add  omelet,  oysters, 
lamb  chops,  mutton,  chicken  fricassee,  beef  steak, 
tomatoes,  peas,  beans;  occasionally,  stewed  fruits  in 
season.  Forbid  tea,  coffee,  wine  and  beer."^ 

*  For  further  information  concerning  the  management  of  the 
child,  see  "  Hygiene  of  the  Nursery,"  by  Louis  Starr,  M.  D.,  a 
book  which  will  be  found  useful  to  both  mothers  and  monthly- 
nurses. 


MANAGEMENT   OF   THE   BIRTH.  35 

MANAGEMENT  OF   THE    BIRTH   IN  THE 
ABSENCE  OF  THE  PHYSICIAN. 

When  the  head  is  apparently  about  to  be  born,  in 
the  absence  of  the  doctor,  place  the  patient  upon  her 
left  side  with  her  knees  drawn  up  and  her  back  near 
the  edge  of  the  bed. 

Scrupulously  cleanse  your  hands  and  arms  as 
directed  on  page  23. 

Cleanse  the  patient's  external  genitals  as  in 
other  cases. 

Expose  and  watch  the  surface  of  the  pelvic  floor 
— the  space  immediately  about  the  genitals  and  anus. 

For  several  m.inutes,  sometimes  a  half-hour  or 
more,  before  the  head  is  born,  the  pelvic  floor  bulges 
outward,  at  least  during  the  pains. 

No  internal  examination  is  necessary. 

As  soon  as  the  head  can  be  seen  at  the  vulvar 
fissure,  place  the  fingers  against  it  and  hold  it  back 
during  the  pains  enough  to  permit  only  very  gradual 
descent. 

This  gives  time  for  the  vaginal  orifice  to  stretch 
and  thus  tends  to  save  tearing. 

In  first  labors  a  half  hour  or  more  will  be  re- 
quired from  the  time  the  pelvic  floor  begins  to  bulge. 

In  subsequent  labors  fifteen  or  twenty^  minutes 
will  usually  suffice. 

If  the  head   is   being  driven   down  too   forcibly 


36  CHILDBED    NURSING. 

ask  the  patient  to  avoid  straining  by  breathing  rap- 
idly during  the  pains. 

On  birth  of  the  head  pass  the  finger  within  the 
passages  to  learn  if  the  cord  is  wound  about  the 
neck. 

If  it  is,  pull  the  loop  or  loops  of  cord  carefully 
down  over  the  head. 

See  that  the  child's  face  does  not  lie  in  a  pool  of 
fluids. 

Immediately  on  birth  of  the  head  place  one  hand 
flat  upon  the  abdomen  over  the  uterus.  ''Watch" 
the  uterus,  with  the  hand  upon  the  abdomen,  till 
child  and  placenta  are  delivered  and  for  a  half-hour 
longer,  till  the  uterus  can  be  felt  to  contract  firmly. 

On  delivery  of  the  trunk  turn  the  patient  upon 
her  back  and  teach  a  bystander  to  watch  the  uterus 
temporarily. 

Make  the  child  cry  out  by  slapping  its  back  with 
the  hand  or  a  wet  towel. 

If  the  child  does  not  breathe  let  an  assistant  hold 
its  body  in  a  basin  of  water  at  a  temperature  of  98^ 
F.,  with  the  head  partially  bent  backward,  keeping 
the  mouth  just  above  the  water. 

Cleanse  the  face  and  spread  a  clean,  coarse  towel 
over  it. 

Press  one  hand  firmly  over  the  child's  stomach, 
close  the  nostrils  with  the  other. 

Applying  the  mouth  over  the  child's  mouth, 
gently  force  air  into  its  lungs  through  the  interven- 
ing towel. 


MANAGEMENT   OF   THE    BIRTH.  yj 

Repeat  twenty  times  per  minute. 

Tie  the  cord  only  after  it  has  nearly  or  quit^ 
ceased  to  beat  at  a  point  near  the  vulva. 

Tie  firmly  an  inch  and  a  half  from  the  navel. 

Tie  again  an  inch  or  two  farther  away. 

Cut  between  the  ligatures,  near  the  first. 

Press  the  end  of  the  stump  repeatedly  w^ith  a  fresh 
towel  to  see  if  it  bleeds. 

Examine  it  occasionally  for  an  hour  or  two  and 
if  it  oozes  tie  again  just  behind  the  first  ligature. 

If  necessary,  compel  the  uterus  to  contract,  by 
friction  or  pressure,  as  directed  on  page  I2. 

Don't  pull  upon  the  cord. 

When  the  placenta  is  expelled,  twist  the  mem- 
branes into  a  rope  by  turning  the  placenta  ov^er  and 
over  till  the  membranes  all  come  away. 

Watch  the  uterus  for  at  least  a  half-hour  longer 
to  make  sure  that  it  contracts  firmly. 


3$  CHILDBED    NURSING. 


GLOSSARY. 

Abdomen,  the  belly;  the  cavity  of  the  body  bounded 
above  by  the  diaphragm  and  below  by  the 
pelvic  entrance. 

Anesthetic,  an  agent  for  producing  insensibility  to 
pain. 

Antiseptic,  preventive  of  septic  poisoning  or  in- 
fection. 

Aseptic,  free  from  septic  poisoning  and  the  germs 
which  cause  it. 

Catheter,  a  tubular  instrument  used  for  drawing 
off  the  urine. 

Defecation,  the  act  of  evacuating  the  bowels. 

Douche,  a  stream  or  jet  of  fluid  projected  against 
some  part  of  the  body  for  cleansing  it,  or  for 
remedial  purposes. 

Drachm,  6o  grains,  i-8  ounce.  In  fluid  measure 
about  a  teaspoonful. 

FCETUS,  the  unborn  child. 

Fundus  of  the  Uterus,  the  upper  end  of  the 
uterus. 

Genitals,  the  sexual  organs. 

Grain,  the  smallest  unit  of  weight;  in  Troy  or  apoth- 
ecaries' weight,  1-480  part  of  an  ounce.  The 
ounce  avoirdupois  is  equal  to  437  1-2  grains. 

Hemorrhage,  bleeding. 

Labia,  lips;  as  applied  to  the  external  sexual  or- 
gans, essentially  the  lateral  halves. 


GLOSSARY.  39 

Ligature,  a  thread  or  cord  of  silk,  or  other  material 
tied  around  a  part  for  the  purpose  of  constrict- 
ing it. 

Lochia,  the  discharge  which  takes  place  from  the 
birth-canal  for  two  to  four  weeks  after  labor. 

Lochial  Guard,  the  napkin  or  other  dressing  worn 
over  the  external  genitals  after  labor  to  re- 
ceive the  lochial  discharge. 

Meconium,  the  dark  greenish  matter  contained  in 
the  intestinal  canal  of  the  new-born  child. 

Micturition,  the  act  of  voiding  urine. 

Navel,  the  point  near  the- center  of  the  abdominal 
wall  at  which  the  umbilical  cord  was  attached 
during  foetal  life. 

Navel-cord,    or   umbilical   cord,    the   cord  which 
.     connects  the  foetus  with  the  placenta.     It  car- 
ries the  vessels  which   supply  blood  to   the 
foetus. 

Ounce,  480  grains;  8  drachms;  1-12  pound  apoth- 
ecaries' weight;  1-16  pound  avoirdupois.  In 
fluid  measure,  1-16  pint;  about  two  table- 
spoonfuls. 

Pelvis,  the  bony  basin  at  the  lower  extremity  ofthe 
trunk. 

Peptonize,  to  convert  into  peptone;  to  partially 
digest.    ^ 

Perineum,  the  body  of  muscular  and  other  struct- 
ures between  the  lower  end  of  the  rectum  and 
the  vagina. 

Placenta,  the  afterbirth. 


40  CHILDBED    NURSING. 

PuBES,  the  prominent,  central  portion  of  the  pelvis 
in  front. 

Puerperal  Period,  the  period  of  about  six  weeks 
following  labor. 

Rectal,  pertaining  to  the  rectum. 

Rectum,  the  lower,  or  pelvic,  portion  of  the  large 
bowel. 

Retention  of  Urine,  excessive  accumulation  of 
urine  in  the  bladder  from  inability  to  pass  it. 

Saturated  Solution,  a  solution  as  strong  as  it 
can  be  made. 

Sepsis,  a  local  affection  of  the  tissues,  or  a  general 
affection  of  the  system  caused,  directly  or  in- 
directly, by  the  presence  of  certain  species  of 
germs.     A  kind  of  blood-poisoning. 

Septic,  pertaining  to  sepsis  or  its  causes.  Affected 
with  sepsis. 

Sterilize,  to  make  germ-free. 

•Suprapubic,  pertaining  to  that  part  of  the  abdom- 
inal wall  directly  above  the  pubes. 

Suture,  a  thread  of  silk  or  other  material  for  sew- 
ing together  the  lips  of  a  wound. 

Umbilicus,  the  navel. 

Urethra,  the  canal  through  which  the  urine  is  dis- 
charged from  the  bladder,  about  i  1-2  inches 
in  length. 

Uterus,  the  womb. 

Vagina,  the  canal  leading  from  the  external  sexual 
organs  to  the  uterus. 

Vulva,  the  external  sexual  organs  of  the  female. 


•?!^ 


DUE  DATE 

FEB  161 

99S    MAR 

IV  m 

.  .\'' 

m 

0  5  i>5« 

1999. 

Printed 
in  USA 

^Q'^S^ 


^' 


Le.wcA.K' 


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